Novel technique of intraosseous arteriogram to evaluate talar viability after high-energy trauma

Abstract

Avascular necrosis (AVN) or osteonecrosis is cellular death of bone components due to the interruption of blood supply. Most available recent data regarding the pathology and treatment of AVN pertains to necrosis of the femoral head, which is most common; followed by proximal pole of scaphoid, body of talus, lunate, and second metatarsal head. Previous studies have confirmed that plain radiographs (XR) are highly specific for advanced disease but exhibit very low sensitivity for the earliest stages of the disease, however MRI remains the gold standard of diagnosis and staging.Core decompression is accepted as an effective treatment option for AVN, most widely described for the femoral head and talus. Successful results have been reported when performed in the initial or pre-collapse phases (Ficat stage 0 through 2); however, less-than-desirable results have been reported when performed in advanced stages (Ficat stage 3 or 4). This study describes a unique, minimally invasive technique using interosseous (IO) arteriogram to determine the prognosis of bones susceptible to AVN after high-energy trauma. This technique was applied after an open, Hawkins III/IV talar neck fracture/dislocation to evaluate the quality of perfusion to the talar dome as a predictor of AVN and structural collapse. Based on intraoperative findings correlated to preoperative XR, area of concern was pinpointed and core decompression was performed and supplemented with implantation of autogenous calcaneal dowel and allogenic bone graft.